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Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury: A Study of 68 Cases With SARS-CoV-2 Placentitis From 12 Countries

Archives of pathology & laboratory medicine (1976), 2022-06, Vol.146 (6), p.660-676 [Peer Reviewed Journal]

COPYRIGHT 2022 College of American Pathologists ;Distributed under a Creative Commons Attribution 4.0 International License ;ISSN: 1543-2165 ;ISSN: 0003-9985 ;EISSN: 1543-2165 ;DOI: 10.5858/arpa.2022-0029-SA ;PMID: 35142798

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  • Title:
    Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury: A Study of 68 Cases With SARS-CoV-2 Placentitis From 12 Countries
  • Author: Schwartz, David A ; Avvad-Portari, Elyzabeth ; Babal, Pavel ; Baldewijns, Marcella ; Blomberg, Marie ; Bouachba, Amine ; Camacho, Jessica ; Collardeau-Frachon, Sophie ; Colson, Arthur ; Dehaene, Isabelle
  • Subjects: Brain ; Causes of ; Clinical Medicine ; Complications and side effects ; Fetal malnutrition ; Infectious Medicine ; Infektionsmedicin ; Injuries ; Klinisk medicin ; Life Sciences ; Medical and Health Sciences ; Medicin och hälsovetenskap ; Patient outcomes ; Statistics ; Still-birth
  • Is Part Of: Archives of pathology & laboratory medicine (1976), 2022-06, Vol.146 (6), p.660-676
  • Description: * Context.--Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear. Objective.--To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Design.--Case-based retrospective clinicopathologic analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. Results.--Of the 3 findings constituting SARS-CoV-2 placentitis, all 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25 of 68) and chronic villitis (32%; 22 of 68). The majority (19; 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. Conclusions.--The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.
  • Publisher: College of American Pathologists
  • Language: English
  • Identifier: ISSN: 1543-2165
    ISSN: 0003-9985
    EISSN: 1543-2165
    DOI: 10.5858/arpa.2022-0029-SA
    PMID: 35142798
  • Source: Hyper Article en Ligne (HAL) (Open Access)
    Alma/SFX Local Collection
    SWEPUB Freely available online
    ProQuest Central
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